Chapter 16-Respiratory Emergencies Flashcards
What happens in the body when you hypo ventilate?
When the lungs fail to work properly, carbon dioxide is not efficiently disposed of and accumulates in the blood. The carbon dioxide combines with water to form bicarbonate ions and hydrogen ions. The result is respiratory acidosis.
What is respiratory compromise related to obesity called?
Pickwickian syndrome
When does hyperventilation occur?
Occurs when people breath in excess of metabolic need by increasing the rate or depth or both, releasing more carbon dioxide than normal. The result is alkalosis.
What does respiratory alkalosis cause?
Numbness or tingling in the hands and feet and around the mouth. If it continues, patients may complain of chest pain and will ultimately experience Carpopedal spasm, during which the hands and feet are clenched in a clawlike position.
What is angioedema?
Acute swelling of the lips and tongue which may be caused by an allergic reaction
Where does pulmonary circulation begin?
The right ventricle
Where do most pathologic conditions occur in the lungs?
In the base
What is cor pulmonale?
Right sided heart failure due to chronic lung disease
What nerve is responsible for breathing?
Phrenic nerve
What are the differences in terms of pulmonary consequences between left sided heart failure and right sided heart failure?
Left sided heart failure typically progresses much faster than right sided heart failure. Right sided failure may slowly worsen over several days, whereas left sided heart failure can kill in a matter of minutes.
What does the right side of heart pump blood to and vice versa?
The right side of the heart pumps blood to the lungs, and the left side of the heart receives blood from the lungs and pumps it around the body
What is paroxysmal nocturnal dyspnea?
Shortness of breath that comes on suddenly in the middle of the night and may be an ominous sign of left sided heart failure.
Sound moves better through fluid than it does air. Given this fact, how does this affect auscultation of breath sounds and the meaning of their findings?
The more air in your patients chest (as in COPD or asthma) the more distant or diminished the breath sounds will be. The more “wet” the patients lungs (as in pneumonia or CHF) the louder the sounds will be at the periphery
What does it mean if the patents words are audible while auscultation of breath sounds?
The patient has consolidation from pneumonia or atelectasis
What are wheezes?
High pitched whistling sounds made by air being forced through narrow airways, causing them to vibrate. Present in asthma, CHF, or when a foreign body obstructs the bronchus
What are crackles associated with?
Increased fluid in the lungs
What are rales?
High pitched crackles heard in the lung bases at the end of inspiration. Consistent with pulmonary edema
What does increased sputum production coupled with fever and chills indicate?
Pneumonia
What does blood tinged sputum possibly indicate?
Tuberculosis
What are cheyene-stokes respirations?
Common omong deep sleepers or the intoxicated. Depth of breathing or volume of snoring gradually increases then decreases (crescendo-decrescendo), followed by an apneic period. Ominous with patients with brain trauma or when apneic period goes from 30-60 seconds.
What are Kussmaul respirations?
Same pattern in neurogenic hyperventilation but caused by the bodies response to metabolic acidosis, attempting to rid itself of blood acetones via the lungs. Seen in DKA. Marked by fruity odor on breath and dry mouth and lips.
What is a key question to ask a patient with chronic respiratory disease when they call 911?
What changed that made you call for an ambulance today?
What is the underlying problem in an asthma attack that responds to treatment but occurs again in a few hours?
Infection such as pneumonia or bronchitis
What has occurred with a patient who has significant pulmonary edema after a lengthy journey?
Patient may have not taken their diuretics while traveling
What is a key contraindication for an antihistamine?
Patients with asthma
What can JVD be a key indication of when the patient is sitting upright?
Can be an indication of right side heart failure which may be the source of dyspnea
What does a pulse oximeter actually measure?
Percentage of patients hemoglobin that has oxygen attached to it
What can give a false end tidal co2 reading?
If the patient consumed carbonated beverages
What is the indication of poor chest compressions in CPR?
End tidal co2 less than 10
What does a sudden increase in ETCO2 Indicate?
ROSC
What do anticholinergic medications do?
Block the parasympathetic response
What is almost always present in patients with dyspnea?
Tachycardia
What is orthopnea?
Shortness of breath induced by laying flat
What can long term corticosteroid use cause?
Cushing syndrome / moon face and generalized edema
What is a good potential treatment for pulmonary edema?
Nitro if BP allows it and pt. Isn’t on ED medications
What are diuretics used for?
Help reduce blood pressure and maintain fluid balance in patients who have heart failure
What is a contraindication for CPAP?
Pneumothorax. Will become tension in only a few breaths
What should you do if you find a patient with a pillow placed behind their head in a respiratory emergency of an unresponsive patient?
Remove it if the patient is snoring. The airway is compromised
What is the best position for a patient who has had a seizure, is hypoglycemic, or intoxicated?
Recovery position. Reduces the risk of aspiration if the patient vomits
What is aspiration?
Inhalation of anything other than breathable gases
What is used to treat airway edema?
Corticosteroids
What is used to treat bronchospasms?
Bronchodilator
What components make up the asthma triad?
Airway edema, bronchospasm, increased mucous production
How do obstructive pulmonary diseases occur?
The positive pressure of exhalation causes small airways to pinch shut, trapping gas in the alveoli. The harder the patient tries to push air out, the more it becomes trapped in the alveoli
What is bronchospasm?
Constriction of smooth muscle that surrounds the larger bronchi in the lungs
What is cardiac asthma?
Acute left sided heart failure
What is hypoxic drive?
A situation where a persons stimulus to breath comes from a decrease in O2 rather than the normal increase of co2
What does poiseuilles law state?
As the diameter of the tube decreases, resistance flow increase exponentially
What is hemoptysis?
Coughing up blood in the sputum
What does coughing up pink frothy sputum indicate?
Severe pulmonary edema, possibly CHF
When a patient tells you they had a sharp pain while coughing and are now short of breath a few minutes or hours later what should you suspect?
Pneumothorax
What is it called when fluid collects between the visceral and parietal pleura?
Pleural effusion
What is a classic hallmark of pulmonary embolism?
Cyanosis does not respond to oxygen
